Between-visit variability in FEV₁ as a diagnostic test for Asthma in adults

Rationale: The reliability of using between-visit variation in forced expiratory volume in 1 second (FEV₁) to diagnose asthma is understudied, and hence uncertain. Objective: To determine whether FEV₁ variability measured over recurrent visits is significantly associated with a diagnosis of current asthma. Methods: Randomly selected adults (N = 964) with a history of physician-diagnosed asthma were studied from 2005 to 2007 and from 2012 to 2016. A diagnosis of current asthma was confirmed in those participants who exhibited bronchial hyperresponsiveness to methacholine and/or acute worsening of asthma symptoms while being weaned off asthma medications. Regression analyses and receiver operating curves were used to evaluate the ability of between-visit FEV₁ variability to diagnose asthma. Results: A current diagnosis of asthma was confirmed in 584 of 964 participants (60%). Between-visit absolute variability in FEV₁ was significantly greater in those in whom current asthma was confirmed, compared with those in whom current asthma was ruled out (7.3% vs. 4.8%; mean difference between the two groups, 2.5%; 95% confidence interval, 1.7–3.3%). However, a 12% and 200-ml between-visit variation in FEV₁, which is the diagnostic threshold recommended by Global Initiative for Asthma, exhibited a sensitivity of only 0.17 and a specificity of 0.94 for confirming current asthma. A between-visit absolute variability in FEV₁ > 12% and 200 ml increased the pretest probability of asthma from 60% to a posttest probability of 81%. Conclusions: A 12% and 200-ml between-visit variation in FEV₁, if present, has reasonably good specificity for diagnosing asthma, but has poor sensitivity compared with bronchial challenge testing. Between-visit variability in FEV₁ is a relatively unhelpful test to establish a diagnosis of asthma.